Analysis Of Risk Factors In Progressive Stroke Of The Posterior Circulation

Objective To investigate the relationship between intracranial and extracranial arterial stenosis, fibrinogen, high-sensitivity C-reactive protein (hsCRP) and progressive stroke(PS) of the posterior circulation.Methods One hundred and six cases of posterior circulation ischemic stroke within24hours of onset were admitted consecutively. Baseline characteristics (age, gender, diabetes mellitus history, hypertension history, coronary heart disease history, history of atrial fibrillation, history of hyperlipidemia, history of smoking, history of drinking, history of cerebral infarction, interval from onset to admission), clinical features (blood pressure, body temperature),laboratory parameters such as blood glucose, low density lipoprotein cholesterol, lipoprotein(a), white blood cell count, hematocrit, high-sensitivity C-reactive protein, fibrinogen and homocysteine were recorded. Neurological deficits were evaluated on admission,72hours later and seven days later by Scandinavian Stroke Scale (SSS) score. Progressive stroke was defined as an increase of SSS score by two or more points.3.0T magnetic resonance angiography was used in evaluating intracranial arterial stenosis/occlusion. Plasma fibrinogen levels were measured by Clauss method and high-sensitivity C-reactive protein levels were measured by immune transmission turbidimetric end point method.Results40out of106patients (37.7%) were diagnosed as PS in this study. The results showed as the following:①Patients with diabetic history were found more frequently in PS group than in non-progressive stroke(nPS) group (χ2=11.02, P<0.01).②SSS scores in the two patient groups were significantly different on72h and7d later(t=13.823～20.756, P<0.01). Levels of hsCRP, fibrinogen and temperature were significantly different between the two groups, While lewels of blood sugar, blood pressure,hematocrit,white blood cell count,low-density lipoprotein, lipoprotein a, homocysteine were no significant difference (t=2.324～18.425, P<0.05).③Between the two groups, parameters such as vertebral artery stenosis/occlusion and basilar artery stenosis/occlusion were significantly different (χ2=4.411～7.71, p<0.05)④Multivariate logistic regression analysis showed that stenosis/occlusion in vertebral artery, basilar artery, history of diabetes mellitus,levels of hsCRP and fibrinogen were independent predictors of PS of the posterior circulation.Conclusion There are complex causes for PS of the posterior circulation. Intracranial and extracranial arterial stenosis/occlusion showed by MRA may predict the occurrence of PS of the posterior circulation effectively. For patients with acute cerebral infarction of the posterior circulation, levels of hsCRP and fibrinogen within48h after admission may be effective predictors of PS of the posterior circulation.